Foundations for the Future: The Leadership of the American Association of Nurse Practitioners Over the Decades

Transcription

1 Foundations for the Future: The Leadership of the American Association of Nurse Practitioners Over the Decades KATHY WHEELER, PHD, RN, APRN, NP-C, FNAP, FAANP ASSISTANT PROFESSOR, UNIVERSITY OF KENTUCKY COLLEGE OF NURSING MICHELLE L. COOK, PHD, MPH VICE PRESIDENT OF RESEARCH, AMERICAN ASSOCIATION OF NURSE PRACTITIONERS JOYCE KNESTRICK, PHD, C-FNP, FAANP PRESIDENT, AMERICAN ASSOCIATION OF NURSE PRACTITIONERS

2 Presentation One: Historical Timeline of the Nurse Practitioner Role in the US and Critical Events Along the Way Kathy Wheeler, PhD, RN, APRN, NP-C, FNAP, FAANP Assistant Professor, University of Kentucky College of Nursing August 2018

3 What is leadership? Leadership Triad Innovation Influence Implementation

4 What is leadership? Leadership is a process of social influence, which maximizes the efforts of others, towards the achievement of a goal Kevin Kruse, 2018

5 What is leadership? Leadership Triad Innovation Influence Implementation

6 What is leadership? According to the 2010 Institute of Medicine Future of Nursing Report Key Message #3: Nurses should be full partners, with physicians and other health professionals, in redesigning health care

7 Adapted REPP Framework-Gimbel, Kohler, Mitchell & Emami (2017) Research Education Policy Partnership

8 Education 1965 Dr. Loretta Ford 1970s-1980s Education starts to shift from certificate to 1971 master s degree Secretary of HEW recommends supporting NP role and monies allocated for programs & Dr. Henry Silver start first NP program at the University of Colorado 1999 Frontier School of Midwifery and Family Nursing establishes NP program using distance education format 2004 AACN recommends all entry-level NP programs transition from master s degree to DNP

9 Policy Scope of practice, title protection, prescriptive authority, other policy issues Controlled Substances Acts of allow NPs to be issued DEA numbers 1986 AANP makes concerted effort to impact national legislation 1995 AANP forms separate Certification Program 1996 Commission on Collegiate Nursing Education is formed 1997 Balanced Budget Act provides direct reimbursement to NPs under Medicare 2008 APRN Consensus Work Group develops the Consensus Model for APRN Regulation

10 Partnership 1985 AANP is established 1975 National Organization of Nurse Practitioners Faculties is established 1989 JAANP begins publication First AANP National Conference is held in Philadelphia 1995 AANP initiates the Corporate Advisory Council to engage with industry leaders 2000 AANP initiates the FAANP program ICN NP/APN Network launches in San Diego, California

11 Research 1986 Office of Technology Assessment publishes analysis of multiple studies of NPs, PAs and CNMs 1974 Burlington Randomized Trial Study finds NPs make appropriate referrals 1987 AANP conducts first member survey 1994 Mundinger publishes study in NEJM that reports NPs are cost-effective and provide quality care 2001 AANP conducts first census of NPs

12 Practice 1999 Approximately 68,300 NPs practice in the 1983 U.S. (AANP, 2028) Approximately 22-24,000 NPs practice in the U.S. (Pulcini and Wagner) 1979 Approximately 15,000 NPs practice in the US (Pulcini and Wagner) 2009 Approximately 130,000 NPs practice in the U.S. (AANP, 2018) 2018 More than 248,000 NPs practice in the U.S. (AANP, 2018)) AANP surpasses 85,000 members (AANP, 2018)

13 Presentation Two: The Springboard to Decision Making and Action-AANP and the Nationwide Nurse Practitioner Data It Keeps Michelle L. Cook, PhD, MPH Vice President of Research, American Association of Nurse Practitioners

14 Outline AANP Research History AANP National NP Database Quantitative & Qualitative Research Focus Groups Annual National NP Sample Survey AANP Network for Research Survey Programs Final Thoughts

15 AANP Research History First AANP Survey Launched American Academy of Nurse Practitioners Established Development of National NP Database Starts 2001 First AANP Census 2006 First Research Coordinator Hired 2013 American Academy of Nurse Practitioners and American College of Nurse Practitioners Merged AANP Research Department Received Added Leadership

16 AANP National NP Database Member/Non-Member Data State Board of Nursing Data AANP National NP Database

17 AANP National NP Database Member/Non-Member Data National Provider Identifier Data State Board of Nursing Data AANP National NP Database

18 AANP National Database

19 AANP Focus Groups NP Research Barriers to reimbursement Transition from volume-based to value-based reimbursement Participation in research Challenges related to delivering high quality patient care Patient safety Advantages and disadvantages of health information technology Association Communication vehicles Membership retention Student expectations myaanp profile fields Survey question wording

20 Annual National NP Sample Survey Practice (Even Years) Identify the characteristics and practices of NPs nationally Identify the services NPs provide patients Determine changes in practice patterns Compensation (Odd Years) Update compensation data as it relates to education, experience, region, setting and specialty Identify typical NP benefit packages and employment arrangements Identify associations between practice characteristics and compensation Identify trends in NP compensation

21 Annual National NP Sample Survey AANP National Database Sampling frame (with addresses): ~48% Random sample Regional stratification Data weighted to be generalizable to the United States and AANP Regions 2017 Response Rate: 14.3% Survey instruments reviewed by AANP practice and government affairs departments & research committee

22 NP Compensation Salary 68,8% Hourly 26,9% Self-Employed 4,3% 0,0% 10,0% 20,0% 30,0% 40,0% 50,0% 60,0% 70,0% 80,0%

23 Salary (Full-Time NPs) Private Physician Practice $ $ Private NP Practice $ $ Private Group Practice $ $ $ $ $ $ $ $ $ U.S. Dollars Base Salary Total Income

24 Variable Pay Due to Performance 30% of NPs received incentive pay and/or productivity bonuses in 2017 Full-time: 31.8% Part-time: 24.9% Top determinants of that incentive/bonus (among those who received one) Number of patient encounters: 46.4% Practice revenue / profit: 38.2% Quality measures / outcomes: 37.9% Patient satisfaction: 26.7% Types / complexities of patients seen: 12.8%

25 Benefits (Full-Time NPs) Employment Benefits Vacation (87.0%) Health insurance (84.7%) Professional liability insurance (76.6%) Dental insurance (71.9%) Retirement plan with employer match (70.5%) Professional Development Benefits CE reimbursement / allowance (79.6%) Professional leave to attend professional meetings or conferences (69.6%) Registration fees for professional meetings or conferences (50.4%) Dues to professional organizations (44.6%) Journal reimbursement / allowance (13.8%)

26 Data Products

27 AANP Network for Research To encourage and facilitate creative, NP-initiated research, relevant to NPs and their patients To facilitate the translation of research to practice To improve the practice of primary care and specialty care by NPs To improve the health of patients

28 AANP Network for Research

29 AANP Network for Research

30 Survey Programs AANP Survey Question Procurement Program Add up to 10 questions to AANP s annual survey for a fee AANP Data Collection Program Collect data at our conferences Purchase physical mailing address lists NPInfluence

31 Final Thoughts Data driven decisions It s a new ERA in NP-focused research. Sparkle

32 Presentation Three: The Consensus Model in the US Who, What, Why and How Joyce Knestrick, PhD, C-FNP, FAANP President, American Association of Nurse Practitioners August 2018

33 Reason for the Consensus Model (2008) Because of the complexity and variety of levels of ordinance of practice for nurse practitioners in the United States, the way nurse practitioners functioned was inconsistent state-to-state and institution-to-institution. Stakeholders from all the advanced practice registered nurse (APRN) organizations in the United States came together to create a uniform regulatory model pertaining to legislation, accreditation, certification and education, the Consensus Model for APRN Regulation (APRN Consensus Work Group, 2008). Implementation of the model is now underway in all states.

34 Advanced Practice Registered Nurse Four Roles certified registered nurse anesthetist (CRNA) certified nurse-midwife (CNM) clinical nurse specialist (CNS) or certified nurse practitioner (CNP)

35 APRN is a Nurse: Who has acquired advanced clinical knowledge and skills preparing him/her to provide direct care to patients, as well as a component of indirect care; however, the defining factor for all APRNs is that a significant component of the education and practice focuses on direct care of individuals.

36 APRN is a Nurse: Who has completed an accredited graduate-level education program preparing him/her for one of the four recognized APRN roles. Who has passed a national certification examination that measures APRN, role and population-focused competencies and who maintains continued competence as evidenced by recertification in the role and population through the national certification program.

37 APRN is a Nurse: Whose practice builds on the competencies of registered nurses (RNs) by demonstrating a greater depth and breadth of knowledge, a greater synthesis of data, increased complexity of skills and interventions, and greater role autonomy.

38 APRN is a Nurse Who is educationally prepared to assume responsibility and accountability for health promotion and/or maintenance as well as the assessment, diagnosis, and management of patient problems, which includes the use and prescription of pharmacologic and nonpharmacologic interventions. Who has clinical experience of sufficient depth and breadth to reflect the intended license Who has obtained a license to practice as an APRN in one of the four APRN roles: certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), or certified nurse practitioner (CNP).

39 The Certified Registered Nurse Anesthetist Is prepared to provide the full spectrum of patients anesthesia care and anesthesia-related care for individuals across the lifespan, whose health status may range from healthy through all recognized levels of acuity, including persons with immediate, severe, or lifethreatening illnesses or injury. This care is provided in diverse settings, including hospital surgical suites and obstetrical delivery rooms; critical access hospitals; acute care; pain management centers; ambulatory surgical centers; and the offices of dentists, podiatrists, ophthalmologists, and plastic surgeons.

40 The Certified Nurse-Midwife The certified nurse-midwife provides a full range of primary health care services to women throughout the lifespan, including gynecologic care, family planning services, preconception care, prenatal and postpartum care, childbirth, and care of the newborn. The practice includes treating the male partner of their female clients for sexually transmitted disease and reproductive health. This care is provided in diverse settings, which may include home, hospital, birth center, and a variety of ambulatory care settings including private offices and community and public health clinics.

41 The Clinical Nurse Specialist The CNS has a unique APRN role to integrate care across the continuum and through three spheres of influence: patient, nurse, system. The three spheres are overlapping and interrelated but each sphere possesses a distinctive focus. In each of the spheres of influence, the primary goal of the CNS is continuous improvement of patient outcomes and nursing care. Key elements of CNS practice are to create environments through mentoring and system changes that empower nurses to develop caring, evidence-based practices to alleviate patient distress, facilitate ethical decision-making, and respond to diversity. The CNS is responsible and accountable for diagnosis and treatment of health/illness states, disease management, health promotion, and prevention of illness and risk behaviors among individuals, families, groups, and communities.

42 Nurse Practitioner For the certified nurse practitioner (CNP), care along the wellness-illness continuum is a dynamic process in which direct primary and acute care is provided across settings. CNPs are members of the health delivery system, practicing autonomously in areas as diverse as family practice, pediatrics, internal medicine, geriatrics, and women s health care. CNPs are prepared to diagnose and treat patients with undifferentiated symptoms as well as those with established diagnoses. Both primary and acute care CNPs provide initial, ongoing,and comprehensive care, includes taking comprehensive histories, providing physical examinations and other health assessment and screening activities, and diagnosing, treating, and managing patients with acute and chronic illnesses and diseases. This includes ordering, performing, supervising, and interpreting laboratory and imaging studies; prescribing medication and durable medical equipment; and making appropriate referrals for patients and families. Clinical CNP care includes health promotion, disease prevention, health education, and counseling as well as the diagnosis and management of acute and chronic diseases. Certified nurse practitioners are prepared to practice as primary care CNPs and acute care CNPs, which have separate national consensus-based competencies and separate certification processes.

43 Model

44 Population Foci Family/Individual Across Lifespan Adult-Gerontology Neonatal Pediatrics Women s Health/Gender- Related Psychiatric-Mental Health

45 The APRN Core courses (3P s) are three separate comprehensive graduate-level courses in: Advanced physiology/pathophysiology, including general principles that apply across the lifespan; lifespan is defined as prenatal through old age and death. Advanced health assessment, which includes assessment of all human systems, advanced assessment techniques, concepts and approaches. Advanced pharmacology, which includes pharmacodynamics, pharmacokinetics and pharmacotherapeutics of all broad categories of agents.

46 Difference between Consensus Model and LACE APRN Consensus Model stands alone as a product of the work done jointly by the NCSBN APRN Advisory Committee and the APRN Consensus Work Group. LACE is broader in nature and is a mechanism to include all interested stakeholders representing the components of LACE in ongoing communications and implementation of the Model

47 LACE Licensure Accreditation Certification Education

48 Who, What, Why, How Who consensus of various nursing organizations including AANP What a method to increase appreciation of the important role that APRNs can play to improve access to high quality, cost effective Health care. Why develop common definitions regarding the APRN roles, appropriate credentials and scope of practice, and create uniformity in educational and state regulations has limited the ability of patients to access APRN care. How- set of standards for all APRNs and movement to reach those standards in the US.

49 LACE Certification Professional Organizations Specialty NP Population Foci Role NP, CRNA, CNM, CNS APRN 3 Ps Graduate Core Master s or DNP Degree

50 Outcomes Movement toward acceptance of the module in most states. Recognition of 4 distinct roles. Standard of curriculum with the 3 Ps. Improved access to high quality care for patients in all populations.

51 Take Home Messages We need to be proactive to achieve Consensus Model Regulation Licensure must be from Boards of Nursing Collaboration and supervision laws are not part of the Consensus Model but still in exist Prescriptive abilities vary Certification is not always required, but mandated by the Consensus Model. Without established equality, APRN s will not achieve adequate reimbursement for funds. Unity and education are key.

52 Questions?? Questions??

53 References American Association of Colleges of Nursing. (2014). Retrieved from American Association of Nurse Practitioners. (2014). Retrieved from American Association of Nurse Practitioners. (2018). Historical timeline. Retrieved from Gimbel, S., Kohler, R., Mitchell, P., & Emami, A. (2017, March). Creating academic structures to promote nursing s role in global health policy. International Nursing Review, 64(1), Institute of Medicine (2010). Transforming leadership. In the IOM The future of nursing: Leading change, advancing health (pp ). Washington, DC: National Academies Press. Johnson, J. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification, and education. Retrieved from Kruse, K. (2018). What is leadership? Forbes. Retrieved from Phillips, S. J. ( 2012). APRN consensus model implementation and planning. The Nurse Practitioner, 37(1), Pulcini J, Wagner M. (2002). Nurse practitioner education in the United States: A success story. Clinical Excellence for Nurse Practitioners, 6(2),51-56 Rounds, L. R., Zych, J.J., & Mallary, L.L. (2013). The consensus model for regulation of APRN s: Implications for nurse practitioners. Journal of the American Academy of Nurse Practitioners, 25(4), Stanley, J.M. (2012). Impact of new regulatory standards on advanced practice registered nursing: the APRN consensus model and LACE. The Nursing Clinics of North America, 47(2),